How India won over polio drop by drop

The World Health Organisation officially declared India to be polio free on March 27 [AP]

The World Health Organisation (WHO) has officially declared India polio-free, with no case of the disease being reported in the country for three years.

For a country long accused of having a broken public health-care system, this hard-won war against polio is validation that decisive political will and effective partnerships between government and agencies like WHO, Rotary clubs and UNICEF can bring about tangible changes with far-reaching consequences.

"While the country did face many challenges like our high population density, inaccessible terrains and widespread illiteracy and ignorance, the very nature of polio also ensured that the sustained campaigns against it succeeded," says Dr R Balasubramaniam, the founder of the Swami Vivekananda Youth Movement and Frank Rhodes Professor, Cornell University.

"While strong government and private partnerships played a huge role, ultimately this victory belongs to the strong network of field workers, community health specialists and volunteers who worked tirelessly to ensure that no part of the country was too inaccessible, no child too far away to vaccinate," Balasubramaniam explains.

In each National Pulse Polio Immunisation round, 2.4 million vaccinators under 150,000 supervisors visited over 200 million households to ensure that the nearly 172 million children, less than five years of age, were immunised with the Oral Polio Vaccine.

Israeli-born photographer Sephi Bergerson has photographed the country’s polio eradication campaign since 2004, as part of assignments from WHO and UNICEF.

"Once I was assigned to photograph volunteers in an area beyond Kusheshwar Asthan Purbi, a little town in eastern Bihar state, along the banks of the Kosi River," he recounts.

"At 3 am sharp they would collect the vaccines from the refrigerators and leave for the boats that would collect them at 5 am with very precise plans to reach every village along the Kosi river. Sometimes there was no electricity and people worked in candle light. Situations could get very rough with many pockets violently rejecting the idea of vaccination but never did I see the volunteers in despair."

Overcoming rejection

Overcoming the rejection of the vaccine by certain communities was perhaps the most important achievements of the campaign.

Ashok Mahajan, a member of the Rotary Club of Mulund, Maharashtra, and partner in the Global Polio Eradication Initiative, knows this first hand.

Appointed to India’s National PolioPlus Committee of Rotary International in 1997, Mahajan realised that unless minority communities were brought into the fold of the campaign, the fight against polio would never end.

"I was working in the Bhiwand area (in Mumbai city) where resistance among the Muslim community was very high," he says. "I knew if we were able to convince the imams of the mosques we would have little trouble vaccinating the children of the area."

He persisted in trying to convince the imams of the Baba Makhdoom Shah Baba Dargah temple, and finally they agreed to talk to the people about the importance of immunisations after Friday prayers.

"They let us put up pro-vaccination posters around the mosque and this made a huge difference," he said. "Once we succeeded in Mumbai, we started work in Uttar Pradesh and Bihar."

The creation of the Ulema committees played a critical role in making immunisation drives successful in the vulnerable states of Uttar Pradesh and Bihar. Convincing these committees was anything but easy.

"Once I was invited to a meeting in a crematorium," he said. "In one village a lady hid her children under the bed, refusing to let us vaccinate them. Her husband had threatened her with a divorce if she let us near them. I had to come back in the evening and talk to him for hours before he agreed."

Lessons learnt

Working in high-risk communities often meant dealing with people at very individual levels. For Augustine Veliath, a former communication specialist with UNICEF for 23 years, they taught field workers important lessons in managing community health.

"We cannot blame the minority community," he said. "Being under-served to start with, they were victims of many false beliefs like thinking polio was an American conspiracy against their children. One lady, in a slum who had turned away every health worker, told me secretly that she was too ill to take her children to be vaccinated. We realised that simply asking for children to be vaccinated wouldn not work. We had to become friends of these poor people who were often very lonely, away from support systems and quite frightened themselves."

The lesson to be learned here is that no child is completely safe until the virus is wiped out from the rest of the planet

Veliath says Bollywood and India’s love for cricket made things much easier.

"The many public service advertisements by celebrities like Shah Rukh Khan, Amitabh Bachchan and our cricketers ensured that people would at least listen," he said. "Actors like the late Farooque Sheikh would tell the field workers, ‘You can make history’ and they did."

While celebrating the achievement, Deepak Kapur, chairman of the Rotary International’s India National PolioPlus Committee, said, "The term that India is polio-free is slightly misplaced. India has not had a reported case of polio over the last three years, but look at the case of China which had been polio-free for eight years before the virus crept in from Pakistan’s infected children. Pakistan and Afghanistan remain endemic and have re-infected countries like Syria, Angola and Somalia."

"The lesson to be learned here is that no child is completely safe until the virus is wiped out from the rest of the planet," he said.

At the helm of the campaign since 2002, Kapur believes that the drive against polio must now ensure to "keep immunisation levels high so that even if the virus re-enters the country, our children aren’t harmed."

"There must be complete readiness to treat every polio case that might emerge as an emergency. States must be equipped to do a large-scale mop up so that the virus does not spread locally," he said.

But some activists say the focus on eradicating polio has come at a huge cost and other critical health issues have been ignored.

"We have ignored cases of acute flaccid paralysis. In the last 13 months, India has reported 53,563 cases of NPAFP (non-polio acute flaccid paralysis) at a national rate of 12 per 100,000 children. This is much above the WHO benchmarks of two per 100,000 cases of immunisation," points out Dr Gopal Dabade, a member of the All India Drug Action Network.

“The polio infrastructure in the country has hijacked every other health concern that is plaguing the country. During the months of the polio drives every other health issue remains ignored. For example, if a child were to be bitten by a snake during that time, it would be hard to find emergency care for it."

While the country seems to have won against polio, sobering statistics in other health-related areas prove that the health situation in the country is far from ideal.

The United Nations Population Fund says that India still tops the global Maternal Mortality Rate and accounts for nearly a third of maternal deaths globally, along with Nigeria.